Everyone knows emergency rooms often make the difference between life and death. We also know that they are expensive. And that the wait times and costs continue to rise, despite large-scale efforts (including the Affordable Care Act) to provide more Americans with health insurance.

Charges associated with providing emergency care 24/7 to the estimated 137 million individualswho visit an ED per year, can be exceptionally difficult to track and to forecast – particularly as costs vary drastically between sites. These charges range from “facility fees” for simply walking through the door to “upcoding,” or billing for the worst possible scenario to acquire more reimbursement dollars from insurers, Medicare or Medicaid.

But the common theme of these practices is that patients can be taken advantage of in moments of crisis. Usually to the benefit of physicians, hospitals or health facilities. Because of that, insurers like UnitedHealth have altered payment policies, aimed at reducing emergency department claims costs. The federal government has also done this, resulting in the American College of Emergency Physicians (ACEP) suing the federal government, HHS specifically, to contest a regulation that impeded emergency physicians from receiving customary payment for out-of-network services.

This merry-go-round for emergency care payments leaves patients confused about whether insurers are trying to hold EDs more accountable and decrease non-emergent use of emergency services, or keep more money in their own pockets by squeezing EDs to the point that many physicians and hospitals can’t meet the bottom line.

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However, a new practice aimed at decreasing reimbursement dollars spent on emergency care has doctors accusing insurers of directly harming patients by retroactively denying insurance payments for ED patients whose diagnoses are deemed not "truly emergencies” after the fact. What this means is that the average American must know, in a given moment of panic, how to properly diagnose whether they are having a real emergency or not… defeating the purpose of seeing an emergency doctor. And this is where Blue Cross Blue Shield of Georgia(an Anthem company) crossed the line for many ED physicians.

On Tuesday, ACEP and the Medical Association of Georgia (MAG) filed suitagainst Anthem BCBS of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial emergency care policy that can retroactively deny coverage for emergency patients. According to the lawsuit, Anthem BCBS of Georgia’s policy violates the prudent layperson standard, a federal law requiring insurance companies to cover the costs of emergency care based on a patient’s symptoms (their reason for going to an emergency room) – not their final diagnosis, as well as prohibits insurers from requiring patients to seek prior authorization before they seek emergency care.

Over the past year, Anthem has implemented this same policy in Indiana, Kentucky, Missouri, New Hampshire and Ohio. Which could mean that more lawsuits are to come. Given the legal efforts by ACEP since 2016 to combat roll-backs in ED reimbursements, it stands that other state-level physicians groups could join forces with ACEP in lawsuits modeled after Georgia's. What is certain is that emergency departments around the country will be paying close attention to this case.